Labor and delivery units are high-risk, high-cost environments in which decisions, mistakes, and delays can have tragic consequences. In our nation's rural hospitals, staff must possess the skills and resources needed to manage obstetric emergencies despite the infrequency of these events. The goal of this project is to bring simulation technology and team performance training, proven in aviation, the military, anesthesia, and other limited areas of medicine, to improve the process of obstetric care and promote safety in rural communities. [unreadable] More than 75 infants die each day in the United States. JCAHO estimates that 2/3 of cases of neonatal death or permanent disability during childbirth are attributable to human factors such as communication errors and almost half due to issues of staff competency. Rural hospitals with limited resources and few providers face considerable challenges in providing emergency obstetric services as required by the Emergency Medical Treatment and Labor Act (EMTALA). This demanding structure requiring nurses and support staff to maintain skill levels and clinical competency in obstetrics despite limited hands-on experience, offers the ideal setting to improve safety through obstetric team simulations. Crew resource management (CRM) (AHRQ Evidence Report number 43, Chapter 44) and medical simulations (AHRQ Evidence Report number 43, Chapter 45), have been recommended by the IOM, JCAHO, and AHRQ as safe practice interventions to reduce errors and risks associated with the process of care. This proposal combines crew resource management and simulation expertise from NASA and the U.S. military, educational and research expertise from academia, and the safety focus of all three to bring simulations where they are desperately needed: to the frontline of clinical care in rural America. Specifically, we aim to test whether simulation of obstetric emergencies and team performance training (CRM) will improve the process of care and patient safety in rural hospital settings through the following AIMS: [unreadable] I. Develop and test standardized Curricula for simulated Obstetric emergency Response Drills & Safety-CORDS [unreadable] II. Implement and evaluate CORDS in rural settings [unreadable] III. Explore the ability of IT to create a statewide safety culture and to expand the reach of simulations. [unreadable] [unreadable] The results of this project will: 1) provide a toolkit that can be used across the country to improve the process of care and promote safety, 2) demonstrate how to use IT and simulated education to support a statewide safety culture and 3) model how to utilize and evaluate the effectiveness of simulations to maintain technical skill levels and enhance the process of care and safety in rural healthcare systems. [unreadable] [unreadable]